To investigate different parameters in SF of patients withsystemic lupus erythematodes (SLE), rheumatoid arthritis (RA)and osteoarthritis (OA).Methods We describe the evaluation of SF in 28 SLE, 41 RA,and 36 OA patients. SF is collected via arthrocentesis in hep-arinized or EDTA tubes. The diagnosis was established in allsubjects prior to SF examination based on typical clinical andlaboratory features. The clinical activity of the diseases at thetime of joint aspiration varied.Results The white blood cell (WBC) count in 28 SLE patients,ranging from 500 to 12 250 with an average count of3473 cells/ml with 55% polymorphic nuclear cells (PMNs),was significantly lower than in RA - 11 048 cells/ml with 75%PMNs. The WBC count in OA patients was significantlylower - 3718±2373 cells/ml. The highest protein levels werefound in RA patients, followed by SLE and OA patients: totalprotein respectively 50.3±6.9 vs 45±7.3 vs 48.6±10.9 g/L andIgG concentration - 21.22±3.53 vs 9.53±4.27 vs 18±2.48 g/L. Circulating Immune Complexes were significantly higher inthe RA group compared to SLE group and OA: 0.247±0.07 vs 0.193±0.05 vs 0.108±0.40 mg/ml.Conclusions The analysis of the SF of lupus patients hasshown elevated levels of WBCs, total protein and circulatingimmune complexes as a markers for the high SLE activity.Synovial fluid is a possibility to define the type of arthritis indifferent rheumatic diseases.

382 ANA AND ENA TESTING ALGORITHM: PERSPECTIVE OFA LARGE PUBLIC HOSPITAL LABORATORY IN NEWZEALAND

K Smith*. North Shore Hospital, Special Assays, Auckland, New Zealand

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Background and aims An ANA and ENA testing algorithm wasestablished at the immunology laboratory at Waitemata DistrictHealth Board (WDHB) in New Zealand. WDHB serves morethan 500 000 people in central New Zealand. Due to thehigh demand for ANA testing, WDHB opted for an auto-mated ANA EIA screening and Extractable Nuclear Antibodies(ENA) EIA reflex testing algorithm, with HEp-2 IFA as anoption when there is a strong indication of false negativeresults.Methods From January 2012 to April 2016, 8515 patientsamples were tested with ANA Screening EIA kits, and 1624samples were reflex tested with ENA EIA kits for detection ofantibodies to SSA, SSB, Sm, Sm/RNP, Scl-70, Jo-1, dsDNAand centromere (Bio-Rad Laboratories, California, USA). Thereflex testing is triggered when either the screening result waspositive or requested by a clinician. ANA IFA tests were per-formed on request.Results The general ANA screening positive rate was 18.5%(1585/8515) in the WDHB population. The positivity rate foreach individual ENA is shown in Table 1. The overall positiverate for ENA testing was 54.8% (890/1624) indicating thatthe ANA screening has been effective in detecting the specificpresence of ENAs.Conclusions Using this ANA and ENA testing algorithm,WDHB was able to screen a large number of patient samplesand quickly identify specific ENA all in one day, resulting inimproved workflow and significant labour and cost savings.

383 PLASMA ADAMTS-13 ACTIVITY IN PROLIFERATIVELUPUS NEPHRITIS: A LARGE COHORT STUDY FROMCHINA

1Y Tan. 1Peking University First Hospital, Nephrology Department, Bei Jing, China

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Background and aims The aim of this study was to investigateplasma ADAMTS-13 activity in proliferative lupus nephritispatients, and evaluate their correlations with clinical, labora-tory and pathological features, especially the vascular lesionsin lupus nephritis.Methods Plasma samples from 163 biopsy-proven class III andIV lupus nephritis patients and 98 normal controls were col-lected. ADAMTS-13 activity was evaluated by residual collagenbinding assay. IgG autoantibodies against ADAMTS-13 weredetected by ELISA. Levels of vWF were evaluated by ELISA.Their associations with clinical, laboratory and pathologicalfeatures were further assessed.Results Plasma ADAMTS-13 activity in lupus nephritis patientswas significantly lower than that in normal controls (84%±21%% vs. 90%±13%, p=0.005). The plasma levels of vWFwas significantly higher in lupus nephritis group than that innormal controls (1.00±0.79 vs. 0.70±0.30, p=0.025). PlamsaADAMTS-13 activity was negatively correlated with the levelof serum creatinine and proteinuria (r=�0.354, p<0.001;r=�0.200, p=0.011, respectively). Patients with higherADAMTS-13 activity had significantly higher levels of factorH (401.51±183.01 mg/ml vs. 239.02±155.45 mg/ml,p=0.005). Plasma ADAMTS-13 activity was negatively associ-ated with the total pathological AI scores ,acute glomerularvascular lesions, acute renal vascular lesions (all p<0.001) andtubular atrophy ( p=0.011). Low activity of ADAMTS-13 wasa risk factor for renal outcomes (p=0.039, HR=0.047,95% CI: 0.120–1.005).Conclusions Decreased ADAMTS-13 activity was found in pro-liferative lupus nephritis patients and plasma ADAMTS-13activity was closely associated with renal injury indices, espe-cially pathological vascular scores. The role of ADAMTS-13 inthe disease need to be further investigated.

384 MULTI-SPECIALISTS’ PERSPECTIVES ON CLINICALDECISION MAKING IN SYSTEMIC LUPUSERYTHEMATOSUS: AN INTERVIEW STUDY

1,2D Tunnicliffe*, 3,4,5D Singh-Grewal, 1,2JC Craig,6S Jesudason, 3,7M.W. Lin,4,8S O’Neill,1,2,8D Sumpton, 1,2A Tong. 1University of Sydney, Sydney School of Public Health, Sydney,Australia; 2Children’s Hospital at Westmead, Centre for Kidney Research, Sydney, Australia;3The University of Sydney, Sydney Medical School, Sydney, Australia; 4The University of NewSouth Wales, Faculty of Medicine, Sydney, Australia; 5The Sydney Children’s HospitalNetwork, Department of Rheumatology, Sydney, Australia; 6Royal Adelaide Hospital, Centraland Northern Adelaide Renal and Transplantation Service, Adelaide, Australia; 7WestmeadHospital, Department of Immunology, Sydney, Australia; 8Liverpool Hospital, Department ofRheumatology, Sydney, Australia

10.1136/lupus-2017-000215.384

Background and aims Clinicians from different medical special-ists are involved in the management of patients with systemiclupus erythematosus (SLE), however, unwarranted variation inpractice remains largely unexplained. This study aims todescribe specialists’ attitudes and perspectives on the manage-ment of patients with SLE.

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Abstract 384 Table 1 Participant characteristics (n=3)

Abstract 384 Table 2 Illustrative quatations

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Methods Face-to-face, semi-structured interviews were con-ducted with rheumatologists, nephrologists, and immunologistsproviding care to adult patients with SLE from 19 centresacross Australia. All interviews were transcribed and analysedthematically.

Results The 43 participants (Table 1) identified five themesand subthemes: uncertainties in judgements (hampered byunknown and unclear aetiology, inapplicable evidence, compre-hending information dispersion); reflexive responses (anchoringto speciality training, anticipating outcomes, avoiding disaster,empathy for the vulnerable); overarching duty to patients

Abstract 384 Figure 1 Thematic schema representing the conceptual patterns and relationships among all the perspectives and attitudes ofspecialists on the managent of patients with SLE. Specialists strived to achieve optimal outcomes for patients with SLE. They managed multiple rolesto meet unmet needs. However, the perceived lack of high-quality evidence, and ill-defined aeitology contributed to their uncertainties in decision-making. To overcome these challenges specialists relied on their experiences gained throughout clinical training and advocated for their patients tohave access to cutting-edge therapies and multidisciplinary care. Although, some felt that existing speciality silos structures restricted access to theseservices.

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(achieving patient priorities, maximising adherence, controllingthe disease, legitimate educator, having adequate and relevantexpertise); safeguarding professional opportunities (diversifyingclinical skills, protecting colleagues’ interests); and optimisingaccess to treatment (capitalising on multidisciplinary care,acquiring breakthrough therapies). Illustrative quotations areprovided in Table 2, and patterns and relationships among allthemes are shown in Figure 1.Conclusions Specialists endeavour to achieve optimal outcomesfor patients with SLE but uncertainties in clinical decisionsarise due to the ill-defined aetiology of SLE, lack of robust,consistent and implementable evidence, and speciality silostructures. Developing tools to support evidence-informeddecisions, generating robust evidence to address clinical prior-ities, and establishing collaborative and multidisciplinary carepathways may support clinical decision making and manage-ment of a complex and heterogeneous disease, and help tominimise unwarranted variation in practice

385 TREATMENT OF RHEUMATOID ARTHRITIS WITHDIFFERENT STRATEGIES IN A HEALTH RESOURCE-LIMITED SETTING LOW-DOSE PREDNISONE PLUSDMARDS MAY BE MAY BE A BETTER ALTERNATIVE

1S Wang*, 1L Lu, 2B Wu. 1Ren Ji Hospital – School of Medicine – Shanghai Jiao TongUniversity, Department of Rheumatology, Shanghai, China Department of pharmacy,Shanghai, China; 2Ren Ji Hospital – School of Medicine – Shanghai Jiao Tong University,Clinical Outcomes and Economics Group

10.1136/lupus-2017-000215.385

Background and aims The application of early treat-to-targetstrategies with biologics has greatly improved the prognosis ofrheumatoid arthritis (RA). But the high cost of biologics placethe a huge burden on the national health systems. Accumulat-ing evidence suggests thatcombinations with tDMARDs andlow-dose prednisone would produce rapid and relevantimprovements in signs and symptoms and has been widelyaccepted for the treatment of RA. Concerns still exist aboutpotential adverse events in the long term. The objective ofthis study was to analyse the cost-effectiveness of combinationof traditional DMARDs and low-dose prednisone compared tobiological therapies from the perspective of Chinese society.Methods A validated lifetime Markov model incorporating theclinical trial data and Chinese unit cost was employed to eval-uate the cost-effectiveness of combination strategy (low-doseprednisone and tDMARDs) and three anti-TNFs in active RApatients. Expected costs, quality-adjusted life-years (QALYs)and the incremental cost effectiveness ratios (ICERs) for aone-year time horizon were calculated in Monte Carlo simula-tion following a societal perspective.Results In comparison with combination strategy, the ICERsfor etanercept, infliximab, and adalimumab were $90488.8,$77295.78, $88961.11 per QALYs. The combination strategywas more cost-effective than any of anti-TNF under the will-ingness to pay threshold when it was set at 3 times the percapita GDP of China ($7557.04).Conclusions Based on this study, the treatment starting withlow-dose prednisone plus traditional DMARDs is the mostcost-effective option for RA patients in the Chinese healthcaresetting.

386 SEVERE PERIPHERAL ARTERY DISEASE IN PATIENT WITHSCLERODERMA MANAGED WITH ENDOVASCULARTREATMENT: A CASE REPORT

1A Widhani*, 2D Antono, 1N Sukmana. 1Faculty of Medicine- Universitas Indonesia- CiptoMangunkusumo Hospital, Allergy and Clinical Immunology Division- Internal MedicineDepartment, Jakarta, Indonesia; 2Faculty of Medicine- Universitas Indonesia- CiptoMangunkusumo Hospital, Cardiology Division- Internal Medicine Department, Jakarta,Indonesia

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Background and aims Scleroderma has been linked to narrow-ing of vessel lumen, accelerated atherosclerosis, and vascularinflammation. Peripheral artery disease (PAD) in sclerodermaranges from Raynaud’s phenomenon to gangrene. Evidence forendovascular treatment for PAD in patient with scleroderma isstill lacking.Methods We report a case of severe PAD in scleroderma man-aged with endovascular treatment.Results Female, 44 years old complained for intermittent clau-dication. She had been diagnosed scleroderma with Raynaudphenomenon since 3 years. She got methotrexate, folic acid,acetylsalicylic acid, nifedipine, and beraprost sodium. Angiogra-phy showed total stenosis at bilateral anterior tibial artery,posterior tibial artery, and peroneal artery. Two drug elutingstents were inserted to the left posterior tibial artery. Balloonangioplasty was done at left peroneal artery. She was alsogiven methotrexate, folic acid, acetylsalicylic acid, clopidogrel,beraprost sodium, and amlodipine. The pain was resolvedafter these treatments.

Eight months after first percutaneous transluminal angiogra-phy (PTA), the patient started having intermittent claudicationagain and cyanotic toes. Angiography showed total stenotic atproximal left anterior tibial artery and 80% stenotic of leftposterior tibialis artery before the stent. The stent was stillpatent at distal left posterior tibial artery. Balloon was insertedto the posterior tibial artery and left plantar foot. Previousmedications were continued, but the dose of beraprost sodiumwas increased and cilostazol was also given. The symptomsresolved after treatment.Conclusions Combination of medication and endovasculartreatment for PAD in patient with scleroderma could providerapid pain relief. Probability of restenosis needs to beevaluated.

387 A CROSS-SECTIONAL STUDY ON APPLICATION OFGLUCOCORTICOID IN SYSTEMIC LUPUS ERYTHEMATOUSPATIENTS IN CHINA

1L xu*, 2Q Guo, 1H Zhu, 1Y Su. 1Peking University People’s Hospital, department ofrheumatology and immunology, Beijing, China; 2Shanxi academy of medical sciences Shanxidayi hospital, Rheumatology and Immunology, Shanxi, China

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Background and aims To explore the status of glucocorticoidapplication in patients with systemic lupus erythematosus(SLE) in China.Methods The SLE patients who meet the 1997 classificationcriteria of American College of rheumatology were enrolled.Epidemiological survey was used. The usage of glucocorticoidand related adverse reactions were recorded and analysed.Results The 400 cases with SLE were enrolled. In thesepatients, the male to female ratio was 1:19. The average age

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